“Our focus is on illness and loneliness”: Volunteer work engagement, compassion satisfaction, compassion fatigue, self‐care and motivations to volunteer

Abstract They are participating as a volunteer implies active personal positioning accompanying others. Evidence supports that experiences of those who experience an illness, who are hospitalised or feel lonely, impact the volunteers: positive emotions like engagement and Compassion Satisfaction (CS) or, the reverse, Compassion Fatigue (CF). Motivations help us understand why volunteers spend their time on these activities. And self‐care practices will be a challenge to counteract the exhausting emotions of volunteering. This research presents a mixed, exploratory and sequential design study on the island of Majorca (Spain). The first phase (n = 216) was quantitative, gathering data from November 2018 to April 2019. Then, the second phase (two focus groups) started with qualitative data collection (July 2019). Firstly, the study determines CS and work engagement levels and examines the relationship between self‐care, CF and motivations. Secondly, the study finds out how they recognise their positive and negative emotions, their relationship with self‐care and what motivates them to be volunteers. The results show that the volunteers report highly positive feelings associated with their volunteering (CS and engagement) and are backed up by a good level of personal Self‐Care. The Understanding and Enhancement motivational functions generate even more positive feelings for the volunteers themselves, who attach a positive value to their experience of caring for others. Despite the positive results collected, we must not ignore the phenomenon of CF in relational volunteering and pain support because it occurs. After all, that could lead to abandonment by volunteers.


| INTRODUC TI ON
Participating as a volunteer in the community individually or as part of a group implies active personal positioning to respond to situations of scarcity or need that we recognise in our surroundings. This paper considers these needs to be satisfied, not only from private or public organisations but also from citizens. Therefore, volunteering is not only a leisure time option but rather a prosocial, planned, not sporadic behaviour carried out within the framework of an organisation and aimed at the care of others (Penner, 2002). Thus, volunteering in health and social care is impossible to carry out individually.
It bases on establishing a helping relationship with the other who experience loneliness or is affected, the person or a family member, by an illness. It would represent volunteering recognised within the primary duality as a form of collective organisation, presented by Hustinx (2010); that is, a person decides to volunteer to change the situation they consider unfair from their mobilising interest.
Pre-COVID-19 time, in Spain, 6.7% of people over 14 years of age participated as volunteers in 2019 -more than half of these were women involved mainly in care-related volunteering such as the field of health and social care (Plataforma del Voluntariado de España, 2019 [Spanish Volunteering Platform]; Plataforma de ONG de Acción Social, 2020 [Social Accion NGO's Platform]). These are volunteers who devote their time to accompanying people in hospital settings (Pérez et al., 2018), in palliative care (Arantzamendi & Centeno, 2017), providing grief support (Becerra et al., 2017;Carneiro et al., 2009) or devoting time and care to someone affected by dementia (Van Der Ploeg et al., 2012).
Thus, according to the categorization of prosocial behaviours offered by Aydinli et al. (2013), we recognise in this volunteering a behaviour that helps others. It is from the establishment of this helping relationship, that the type of "relational volunteering" (Cañas-Lerma, 2020) analysed in this research is built. It is a type of volunteering linked to a high emotional load. Establishing a helping relationship is essential because it is volunteer work focused on caring for the person who experiences suffering and aimed at alleviating their discomfort. Therefore, our empathy plays a fundamental role in offering this therapeutic relationship to the other. It is empathy that brings us closer to the experience of the other, to understand "as if" it was happening to us and offering ourselves, from our role as volunteers, to care for the other from a compassionate and considerate perspective. Yet it is at this point where we emphasise the social-health volunteers. By offering themselves as a care resource, they become exposed to the inference in them of positive feelings and more complex and exhausting feelings deriving from the pain, discomfort or injustice experienced by others.
Being permeable beings that offer themselves as a care resource will make them infer positive motivations and emotions -Compassion Satisfaction and volunteer work engagement-and other more exhausting and complex ones -Compassion Fatigue (Hidalgo-Andrade & Martínez-Rodríguez, 2019;Meneghini et al., 2018;Montross-Thomas et al., 2016). For this reason, it is vital for the wellbeing of the volunteers that they become aware of themselves and participate in or promote self-care strategies to elevate or maintain a good level of positive feelings. In this sense, this study connects the first information approach of this type, including self-care practices in volunteering.

| Compassion satisfaction
Establishing a caring relationship based on empathy can generate positive emotions for us. Feeling connected to others is an essential component of compassion, and participating in volunteering, which produces feelings of commitment and interconnection with others, arouses satisfaction in us (Snyderman & Gyatso, 2019). For Stamm (2010), Compassion Satisfaction is one of these positive emotions. She defines it as the personal reward generated by the knowledge that we are offering ourselves as a therapeutic resource to others. West et al. (2018) point out that it reflects our resilience and ability to give a meaning of enrichment and personal growth to those stressful experiences and/or relationships. Some factors that can help increase Compassion Satisfaction in support's volunteers in pain, illness or loneliness are the use of personal rituals (Montross-Thomas et al., 2016) or self-perception of having social support (Di Marco et al., 2020). To participate in a flexible environment, accepting death as part of life, and knowing how to maintain an adequate personal and emotional distance (Guirguis-Younger & Grafanaki, 2008) are others strategies.

| Compassion fatigue
The emotional cost involved in caring for others from a relationship based on empathy is what Figley (1995a)

recognises as Compassion
What is known about this topic • Compassion Satisfaction and Compassion Fatigue are developed significantly in professional areas like nursing and social work, but not in volunteering.
• Self-care in volunteering is not widely investigated, and it is necessary to continue expanding knowledge.
• Social workers and volunteer organisations consider the motivations of volunteers to promote volunteering.

What this paper adds
• High levels of Compassion Satisfaction and engagement generate continuity of the person volunteering with the same organisation.
• Memorable pain-related experiences have given positive value to their volunteer experience.
• The results obtained are of interest to increase the permanence of volunteers from the social-health field.
Fatigue. It appears when the person is emotionally exposed to the pain and discomfort of the other and does not have personal or organisational support to cope with this unpleasant situation (Figley, 1995b). Signs that indicate a high level of Compassion Fatigue can arise quickly. It may well be related to one harrowing experience in particular or long-term exposure to different understandings of the pain of others (Alkema et al., 2008). Some of these signs are apathy, annoying thoughts or mental images related to the other's painful experience, questioning of spiritual beliefs, isolation and insomnia, among many others (Absolon & Krueger, 2009;Figley, 1995b;Kreutzer & Jager, 2011;Moreno-Jiménez et al., 2004).
In addition to the factors Figley (1995b) recognises as generators of high Compassion Fatigue the absence of self-care behaviours, unresolved personal trauma, high tension derived from an inability to handle the work, and lack of feelings of satisfaction concerning the work carried out. In health and social care volunteering, there are other factors non-protective to experience Compassion Fatigue. These factors are lack of a volunteer code of ethics (Avieli et al., 2016), having anxiety or depression (Jo et al., 2020), and dealing with the death of a user, among others (Pöyhiä et al., 2019).

| Engagement
Participating in a volunteer means doing it under the umbrella of an organisation. In this sense, strengthening and emotional management are significant, from the organisations themselves (Salanova et al., 2016), including those that manage volunteer programs. From this approach, engagement is the positive feeling related to the work carried out, not specifically with a particular activity or task, but in general terms (Schaufeli et al., 2002). Despite being a term initially linked to work environments, Vecina et al. (2012) analysed it with a sample of volunteers, obtaining significant results. Engagement is made up of three constructs. For Schaufeli et al. (2002), vigour is the ability, despite difficulties, to be resilient, to strive and persevere in whatever is being done in the organisational setting; dedication is an excellent feeling of significance with the role played within the organisation and the pride this generates, in this case being a volunteer. Finally, absorption is the ability to control a situation, the enjoyment of concentrating on what is being done and the feeling that time passes fast while performing the role.

| Motivational factors for volunteering
In addition to the pleasant feelings of Compassion Satisfaction, and Engagement, other individual elements intercede in the causes whereby a person starts or carries on health and social care volunteering (Selli et al., 2008). Recent studies reported a positive association between older people's volunteering, cognitive functioning (Guiney et al., 2021;Han et al., 2020), physical health   Authors are according with Haski-Leventhal's (2009) theoretical proposal based on altruistic motivations or civic concerns. Likewise, this study shares the approach of Clary and Snyder (1991). After a bibliographic review, they stated that greater satisfaction and effectiveness in volunteering occurred in those cases in which the volunteer work established a psychological function for the volunteers themselves. The functional motivation theory (Clary et al., 1992) adopts a functional approach along these lines. It develops a model Different studies relate to motivation and its positive relationship with satisfaction and retaining volunteers (Faletehan et al., 2020;Meneghini et al., 2018;Mullan et al., 2021). In this sense, Ferreira et al. (2012Ferreira et al. ( , 2015, identified four different motivation categories with hospital volunteers, and their positive relationship with satisfaction and intention to stay: development and learning, altruism, protection and career recognition.

| Self-care is a strategy to appease negative feelings and maintain positive ones
The concept of self-care is deeply rooted in the professional world but not in the same way in volunteering. There is a false myth about selfcare, stating that it is a selfish practice, but nothing could be further from the truth (Miller et al., 2018). It is about caring for oneself. This self-care may be physical (activity and physical care in daily life), internal (taking care of one's inner world) and social (attending to the optimal care of our social and organisational relationships (Galiana et al., 2015)).
Relational volunteering provides support in a hospital or residential setting. It brings the volunteer close to significant personal experiences where affection, tenderness or joy appear and emotional or physical pain, frustration or illness. Therefore, this exposure to the feelings and realities of others requires self-care guidelines to miti-

| Purpose of the study
In the quantitative part of the study, the first objective was to determine the levels of compassion satisfaction, volunteer work engagement, self-care, compassion fatigue and motivations in health and social care volunteers and examine the relationship between them.
In the qualitative part, the second objective was to find out how participants recognise and process their positive and negative emo-

tions (Compassion Satisfaction -CS, engagement and Compassion
Fatigue -CF), their self-care relationship and what motivates them to be volunteers in the sphere of illness and loneliness.

| Procedure and recruitment
This research has a mixed, exploratory and sequential design. The mixed-methods design was chosen to highlight not only quantitative data but also participants' voice. Thus, quantitative data allow statistical procedures that contribute to offer guidelines in the population studied, and the qualitative approach allows the access to deepen in descriptions of the phenomena studied. The first phase was quantitative (Q-1), gathering data from November 2018 to April 2019.
The second was qualitative (Q-2), gathering data in July 2019. The first author contacted with organisations (n = 17) offering volunteer programs for supporting people in palliative care, older adults with multiple pathologies with good cognitive ability or in a situation of unwanted loneliness, or persons in drug-abuse treatment program.
Volunteers visit them at home, in hospitals or older adults' homes on the island of Majorca (Spain). Sixteen organisations agreed to send our invitation to participate in the study out to their volunteers. E-mails were sent to the volunteer coordinators explaining the purpose of the study and requesting their cooperation in the volunteer recruitment process. The coordinators of the volunteers organised the meetings as the researchers could not access their contact information in the Q-1 phase. The participants in this phase had identified through snowball sampling and word-of-mouth sampling. According to the levels of CS and CF, the research team organised the inclusion criteria for the focus group participants' in the Q-2 phase. At this point, the intention was to gain insight into the experience and meanings of support volunteers' expertise and their description of their CF emotions, recognising CS, engagement, motivations and self-care practices in their volunteering.

| Sample
Participants' characteristics are presented in Table 1.

| Participants qualitative part (Q-2)
Participants in the Q-2 phase (n = 191) were selected according to their levels of CS and CF, using a random sampling procedure with Excel software. The final sample consisted of 13 participants divided into two focus groups. The selection of participants was from an intentional stratified sampling to find out and describe in detail the characteristics, either similar or different, which occur in the subgroups (Teddlie & Yu, 2007). The inclusion criteria for the first focus group (four women and three men, ranging in age from 24 to 71 years) were as follows: (1)  (2) low CF; (3) high CS. Participants were retired (n = 6) or paid workers (n = 6).

| Quantitative part (Q-1)
The sociodemographic form includes gender, age, level of education, work situation and volunteer-related variables (length of volunteer service in months and total days).  (Stamm, 2010). With the permission of ProQOL.org, we exchanged "helper" or "help" for "volunteer" It is selected because although it is a construct that initially arises for the study of paid work people, volunteering management has many similarities with positivist organisational behaviours (Vecina et al., 2012). Responses are based on a three 3-item subscale, with anchor points ranging from 0 (never) to 6 (always). In this study, Focus groups: the two groups were facilitated using a question guide to prompt discussion. We adapted, by way of stimulator material (Barbour, 2013), the collective narrative practice "The tree of life" (Denborough, 2008). Our adaptation, "The Volunteering Tree", in its

| Data collection and analysis
All the statistical data were analysed using IBM SPSS software version 25. The Kolmogorov-Smirnov test demonstrated the absence of normality in data distribution, so nonparametric statistics were used. Univariate and bivariate descriptive data analysis, correlations and contrast tests such as Mann-Whitney U, Kruskal-Wallis and Spearman's Rho were performed. Missing data were handled by using the "Exclude cases listwise" option in SPSS.
The two focus groups were digitally recorded, transcribed verbatim and coded using the constant comparative method: data reduction, unitizing, open coding and axial coding (Glaser & Strauss, 1967).
To provide strong evidence for interpreting the data, investigator triangulation was used to analyse transcripts and develop emergent and adapted aprioristic themes independently. Data were analysed using Atlas.ti software version 7.5.4.  Correlations between variables are shown in Table 2.  Respecting the bivariate analysis, no significant differences were found in the mean questionnaire score for gender and education variables and CS and CF, whereas significant differences were encountered between gender and Self-Care (U Mann-Whitney

| Qualitative findings
The relationships collected in the quantitative data were enriched from the emotionality provided by the qualitative data.

| Suppression of own emotions and CF
In the words of participant 4_FG1, "But the moment I'm with the person I have an emotion, which is there, that I try not to be moved or cry or anything, but when I leave, I say, I was moved.     3.1.3 | Self-care and CS and CF In both groups, behaviours related to self-care and regulation of the emotional state were collected. It is significant that FG_1, whose participants presented a medium level of CF, were the ones who most manifested the need to be aware of their emotional state concerning volunteering. Participants shared, "That's why attention to emotions is so important to being a volunteer" (5_FG1); "I always say, emotion is fundamental. But don't let it drive you" (4_FG1). Yet it was the participants in FG_2 who widely recognised the phenomenon of CF and contributed coping strategies for it, "I give what I can right now, but I'm aware that the problem isn't solved" (9_FG2); "I think it's inevitable that you sometimes get worn down. There may, sometimes, be a connection, something from our past that touches us personally, but that sometimes makes it harder. Sometimes you must work on yourself emotionally. You see yourself in the other person because you see yourself, your own story (…) realize that when it's…. I experiencing an emotional toll, knowing how to manage it" (12_FG2).

TA B L E 4 Distribution of mean scores by volunteer functions and statistical significance
Likewise, both groups recognised the exercise of volunteering in itself as a strategy of self-care: "(…) And a lot of satisfaction, gratification, and emotional well-being. It gives me a lot of good things" (10_FG2).

| Understanding function and CS
There are primarily stories linked to learning life lessons that provide satisfaction, "I've had a great learning experience, and all these people have given me wisdom. Generally, the sick people themselves.
(…) And we've had abusers as users… all sorts, and when you see them, they're no more than just a person, and we aren't judges, and we can't judge. (…) And the wisdom they give you, they all teach you something… it satisfies you" (6_FG1). Learning that enables exploratory knowledge about the very meaning of life itself, "Learning the meaning of life through the contact this volunteering affords me.
When people are near death, they've never been so alive in their life.
Because they're aware they're alive and that we're here and we let each day go by" (12_FG2).

| Enhancement function, the feeling of giving back and CS
Both groups recognised the satisfaction generated by participating as volunteers. Therefore, their improvement in their state of mind, as well as in their perception of themselves, "For me, the experiences I've had have helped me be a better person" (12_FG2); "me too, also, living the volunteer experience has enabled me to feel that I'm a better person, that I can help" (13_FG2). It is worth noting the cases in which volunteers have previously been on the receiving end

| DISCUSS ION
The sample follows the trend of volunteering in Spain (NGO Platform for Social Action in Spain, 2020), primarily women of advanced-adult age (M = 58.33, SD = 16,868). It is possibly due to the improvement in the quality of life and life expectancy in Spain, which allows women to reach this time in better physical and cognitive conditions.
Our results show similarities with the work of Slocum-Gori et al. (2013), regarding CF and CS levels. It seems that CS could be a reason for their continuity in the volunteer work, despite being in contact with pain, anguish or emotional discomfort. Despite this, the results obtained in this study are aligned with those presented by Di Marco et al. (2020), and no significant relationship was found between CS and CF. One explanation for this may be that all the participants scored high levels of CS, and therefore there was no dispersion of data that would allow a correlation, although a slight trend towards this was observed. Likewise, the qualitative data suggest a clear picture of these results since discussion group FG_1 argues that CS and CF can be felt simultaneously, with one feeling not affecting the other.
The negative relationship obtained between CF and Self-Care could also be related to the high CS levels obtained. That is, the higher the level of Self-Care, the lower the level of CF, which could generate compensation for positive feelings such as CS, as argued by Moreno-Jiménez et al. (2013), Potash et al. (2015) and Pintado and Giannini (2016).
Volunteering is a non-compulsory activity in opposition to pro- ing with people interested in growth and learning, contributions that they recognise their volunteering offers them, therefore generating beneficial feelings like in Faletehan et al. (2020) or Ferreira et al. (2012. Likewise, as it is essentially a sample of retired people, as in Wilson and Musick (1997), the Enhancement function can be recognised to have a relevant role since, through their volunteering, they can feel involved and capable of contributing to society according to Russell et al. (2019), Jongenelis et al. (2020) and Wilding et al. (2021). Along the same lines, it is logical that the Career function should appear last since they have mostly finished their professional careers.

| CON CLUS IONS
Being a volunteer in settings involving illness and suffering could imply a high emotional cost. However, the results obtained in this work show that the volunteers who spend time and support with hospitalised or lonely users, report highly positive feelings. CS, Engagement and the tree constructs comprising it are associated with social and health volunteering, as well as good levels of personal Self-Care. Likewise, carrying out this type of volunteering fulfils all the functions of Understanding and Enhancement, generating even more positive feelings and adding a positive value to their experience of caring for others. These results are relevant to design organisational initiatives to motivate and retain volunteers in social and health programs. Thus, organisations should help volunteers to identify their positive and negative emotions, promoting self-care practices and group interventions to share and work on those feelings. Finally, since high levels of CF may lead the cause to stop volunteering, social and NGO policies could encourage volunteering programs that prevent high CF.

| Limitations
This study has some limitations. First, this study was developed prior to COVID-19 pandemics. Thus, further studies should analyse the impact of lockdowns in the volunteering task, to know how volunteers and users experienced the interruption of their relationships.
Moreover, given the impossibility of having a precise census of the total population of volunteers in Mallorca, there is no data regarding the continuity of volunteers showing higher levels of CF.
More studies related to the reasons why people decline to carry on volunteering may contribute to design initiatives to increase the retention of these individuals.

ACK N OWLED G EM ENTS
The authors acknowledge the study participants for their contribution, as well as Malorca's organisations offering volunteer programs for supporting people in palliative care, older adults with multiple pathologies or in a situation of unwanted loneliness, or persons in a drug-abuse treatment program, for their support in this research.
We also express our gratitude to all who care for others with compassion in times of distress.

FU N D I N G I N FO R M ATI O N
The authors received no financial support for the research, authorship, and/or publication of this article.

CO N FLI C T O F I NTE R E S T
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

DATA AVA I L A B I L I T Y S TAT E M E N T
Quantitative Data Availability Statement: The quantitative data and syntaxis that produce the findings reported in this article are available at [https://osf.io/63c84/ ?view_only=cae13 f3390 c64ae 896dd 1457a 0b06453].
Qualitative data that support the findings of this study are available from the corresponding author upon reasonable request.